Adult Social Care: Broken Promises

The other day I asked a well-informed Tory peer when we should expect the long-delayed adult social care Green Paper. “Not in my lifetime” came the response. Recent history begins with the 2011 Dilnot Report which was accepted by the coalition government, welcomed by the Labour party and then rightly over-ruled by HM Treasury as being impractical and too expensive.  It was, or should have been, a start. 

There was much talk of achieving cross-party consensus, but no action, and it was left to Select Committees to fill the gap. The government response to the Health Committee’s 2012/3 report included “The Government will work with stakeholders and the Opposition to consider the various options for what shape a reformed system could take, based on the principles of the [Dilnot] Commission’s model, in more detail before coming to a final view on reforming the system in the next Spending Review.” 

The Health and Social Care and Housing, Communities and Local Government Committees published a joint report in June 2018. Their four main principles were: 

• Ensuring fairness on the ‘who and how’ we pay for social care, including between the generations

• Aspiring over time towards universal access to personal care free at the point of delivery

• Risk pooling—protecting people from catastrophic costs, and protecting a greater portion of their savings and assets

• ‘Earmarking’ of contributions to maintain public support” 

The Care Minister could not comment as the Green Paper would follow “this autumn”. Her letter was undated, so the autumn to which she referred is still unclear.  

A Commons Library briefing note has a timeline of Green Paper postponements up to September 2019.  Amongst them are: “January 2019 – Mr Hancock told the House that he ‘intends’ for a social care Green Paper to be published ‘by April’”.  When there was no sign of it by the end of April, he “attributed the ongoing delays to a lack of cross-party consensus”.  As the Opposition pointed out, there was nothing to be consensual about. 

In a speech to the Local Government Association (LGA) in July 2019, Matt Hancock said “Infamously, during the 2017 election campaign. But more recently too – when my colleague Damian Green recently proposed a scheme very similar to a plan supported by not one but 2 cross-party Commons select committees, by 10:42am on the day of the launch, the Shadow Chancellor had condemned it as a ‘tax on getting old’. It’s not the first time narrow partisan politics has got in the way of a solution, but let us hope it’s the last.”  

It was naïve of the Tories to assume that Select Committee agreement equalled cross-party consensus and still more to rush out such a controversial plan mid-campaign. Labour also called it a “dementia tax” and it nearly cost Mrs May the 2017 election. 

Significantly, when the senior civil servant, Jon Rouse, Director General for adult social care, left in 2016, he was not replaced until this year. The 2012 Health Act was supposed to leave NHS matters to NHS England, with the Department of Health and Social Care (DHSC) attending more to the last part of its title. That has not happened: the vast majority of DHSC announcements have referred not to social care, still less working age social care, but to the NHS – ignoring Sir Simon Stevens, its CEO of NHS England, who is more than capable in speaking for his own organisation. In July he tried to balance the picture by demanding an adult social care Green Paper within the year. 

Hancock’s LGA speech referenced above gave an indication of his Green Paper thinking, in brief: “integrated care systems (ICS), bringing together the NHS with local authorities”, “health and wellbeing boards”, “specialist training”, “better leadership”, “increasing the Carers Innovations Fund”, “more control for care users” and “tech”. 

Some of this is sensible enough, some just adds bureaucracy and some are junk-filled platitudes. Care users cannot get what they want if it is not available.  We were 122,000 carers short the last time I looked.   We know the DHSC’s record with new IT, test and trace apps being the most recent example, so do not hold your breath for “Social prescribing apps are being integrated with GP systems to give people greater access to social activities in their communities that can help improve physical and mental health.” The idea one needs an app to get the GP to prescribe riding a bicycle is ludicrous. 

What these seven components of the Hancock vision fail to include are the three essentials: more money for carers, greater professional status akin to nurses to build pride in the profession, and less bureaucracy giving them more time and freedom to do what they believe to be best. 

Nor is there any discussion of finance.  HM Treasury has probably been blocking any social care Green Paper and are likely to continue to do so.  That ignores individuals’ increasing willingness to contribute towards their own old age costs.  French and German insurance companies offer cover and most of those who can afford it take it up.  There’s only a 40 percent chance one will have to spend one’s final months in a care home.  The government has made no effort to encourage British insurers to follow suit.

The broken promises did not stop there. During the last election Boris Johnson claimed a Green Paper consensus would be developed within 100 days of being elected. At nearly the end of that, nothing had happened and Hancock wrote to all peers and MPs saying, in effect, that as he had no clue, please would they send in any ideas about reforming social care. And although care for the elderly gets all the headlines, about half of adult social care costs are for those of working age.  

The current excuses for the broken promises, namely Covid and the upcoming financial crisis, do not hold water. Thousands of DHSC civil servants have been sitting at home on full pay with little to do but write the Green Paper.  We need an adult social care strategy that will do the job, as the NHS has, for decades. This demands some degree of political party consensus. Any party that fails to respond constructively to a sensible Green Paper will pay the price at the polls.  And the strategy does not have to begin tomorrow; it should start as soon as we can afford it.  The failure to deliver rests squarely with this government.